My 25th ACOG Rejection While Black Maternal Death Continues to Rise

Dear Dr. Abbasi-Hoskins:

Thanks for your response regarding my 25th rejection to become a member of ACOG’s  Medically Underserved Women’s Committee. Please be advised that I will not be submitting any future applications.

Although I have paid my annual dues for the past 25 years, I cannot guarantee that I will continue to do so in the future.

Have you noticed the dwindling number of obstetricians-gynecologists who pay their dues, especially those who look like me?

Although I originally planned to write a lengthy letter, my former high school photographer teacher (may he rest in peace) once said, “A picture is worth 1,000 words.”

The picture of this Black woman’s unassisted homebirth speaks volumes and represents our dismal failure as effective clinicians in keeping pregnant women safe and unharmed. Some Black women would rather stay home and deliver their babies in a tub without assistance than come into a hospital where they are often disrespected, ignored, and clinically mismanaged. How do we change that narrative?

This week’s JAMA opinion hits home. Medicine is an art as well as a science. Since ACOG will not allow me a membership to the Medically Underserved Committee, let me offer this advice based on my 35 years of clinical and professional experience:

  1. Stop allowing ob-gyn residents to “cut and paste” history and physicals and feign them as their own. This practice represents cheating and does not enhance their clinical acumen. How are residents supposed to learn if they use someone else’s data?
  2. Initiate mandatory competency exams regarding the diagnosis and management of preeclampsia. Some residents do NOT know how to manage preeclampsia effectively, and I have reviewed those dismal malpractice cases to prove it: The case of the late Dr. Chaniece Wallace is a prime example. The state of Indiana could use some much-needed help.
  3. Adopt the California Maternal Quality Care  Collaborative’s clinical guidelines that have proven they can reduce maternal mortality. The present ACOG clinical guidelines for the management of preeclampsia are as clear as mud, especially as it relates to patients who demonstrate preeclampsia symptoms before 39-weeks. My late residency director, Dr. Sterling Williams, former V.P. of Education at ACOG, is greatly missed. We did not have confusing clinical guidelines when he was alive.

I wish you a successful year as the new ACOG president and hope you will consider some of my recommendations.

Respectfully,

Linda Burke (formerly Burke-Galloway), MD, MS, FACOG

The Deadly 17 Minute Cesarean Section: In Memory of Kira Johnson

The public should be wary of certain physicians, and the late Kira Johnson’s physician is one of them.

According to Case No. 800-2016-021723, the California Board of Medicine received six complaints of medical negligence against Dr. Arjang Naim, who is a board-certified obstetrician-gynecologist who practices in Los Angeles and Beverly Hills, California.

On April 12, 2016, Johnson entered Cesar Sinai Hospital for an elective C-Section accompanied by her family but left the hospital without her.

I attended medical school and did my internship with men like Arlang Naim and know them well. Cowboys is what we called them back in the day. They took pride in whizzing through operative surgeries like they were in a race against time. Safety rules did not apply to them. They breached standards of medical care, and no one held them accountable.

In cases of emergency C-sections, the expected length of time is thirty minutes. Kira Johnson had no emergency conditions, and her C-section was an elective procedure. Naim had two medical practices in Hollywood and Beverly Hills and was probably multi-tasking.

Johnson’s procedure began at 2:31 p.m. and ended at 2:48 p.m., 17 minutes, including her delivery. Unfortunately, in Naim’s haste, he failed to close the bladder flap. Shortly after that, he left the hospital, leaving Johnson’s care to the resident physicians who were in training.

At 4:40 p.m., Johnson developed abnormal bleeding in the bag that collects urine (known as the Foley catheter). Then, at 5:45 p.m., a massive blood clot could be felt through her skin incision. Her pulse then increased dramatically, and is a classic sign of impending shock.

Johnson received multiple blood transfusions and exhibited signs of a dangerous condition called DIC (disseminated intravascular clotting) which meant her blood was not clotting properly. Naim did not arrive at Johnson’s bedside until 8:47 p.m. Despite Johnson’s unstable condition, he wrote orders, including a CT scan and then LEFT THE HOSPITAL.

Johnson’s condition deteriorated further, and the resident physicians called Naim again. He arrived at the hospital at 11:45 p.m. but only wanted to continue to merely observe. However, the resident physicians convinced him to return to the operating room to determine the site of her bleeding.

At 12:25 a.m., Johnson was taken back to the operating room, and at 1:15 a.m., the resident physicians scrambled to find a general surgeon to assist Naim with the procedure. Unfortunately, Kira Johnson’s heart stopped beating.

Further evidence from the California Board of Medicine reported that Johnson was not the only patient who experienced medical neglect.

  1. On August 21, 2015, a patient had a ruptured tubal pregnancy. Naim performed her surgery but failed to achieve any follow-up hospital care for three days despite her requiring a blood transfusion
  2. On March 14, 2016, a patient had a ruptured uterus after experiencing a 16-week pregnancy loss. The uterus was repaired, the patient required a blood transfusion, and Naim did not see the patient during her entire hospital stay.
  3. On May 31, 2016 (approximately one month after Kira Johnson expired), Naim performed a C-section on his patient with a placenta previa (placenta covering the baby). Unfortunately, the placenta could not be removed, and the patient required a hysterectomy performed by Naim and a GYN oncologist. Although it was Naim’s patient, he failed to see her daily during her hospital course.

The California Board of Medicine placed Naim on probation in 2018 for two years, but he is practicing medicine again, including delivering

Would you want him to be your physician?

My Mother Would Die if She Gave Birth to Me Today

Used with permission of E Bere Illustrate

If my mother gave birth to me today instead of over 60 years ago, she would probably be dead based on her risk factors. She was Black, had gestational diabetes, and gave birth to a 9-pound 4-ounce baby girl via C-section. She would have been discharged from the hospital on post-op day four rather than post-op day seven. But, thank God, my mother, unlike her mother, lived. I never knew my grandmother because she died from postpartum cardiomyopathy at age 39, a few months after delivering my youngest aunt in 1939.

When my mother had me, there were no managed care organizations that booted women out of the hospital 48 hours after birth or 96 hours after having a C-section. Had the federal government not stepped in with the Newborn and Mother’s Health Protection Act of 1996, mothers and babies would have been sent home after 24 hours, a phenomenon sarcastically referred to as “drive-through deliveries.”

In the discussion of reasons for the ignominious U.S. maternal mortality rates, the topic of managed care organizations and private equity investors is never discussed but should be.

According to Medical Economics, the Medical Management Group Association (MMGA) reported $60 billion in “deals” involving medical practices in 2019 by private equity firms. They are one of the reasons why nurses are leaving hospitals, physicians are jumping off hospital roofs, and yes, women are dying within a week of having a baby, and the stillbirth rate has increased.

The business model is not taught in nursing, midwifery, or medical schools. As a result, we do not know how to compromise quality care and satisfy your shareholders simultaneously. Perhaps if hospital CEOs and private equity shareholders are named co-defendants in future medical malpractice cases, the maternal mortality rate will move in the opposite direction.

You profess not to know why more pregnant women are dying? Try taking a closer look at your priorities and business practices. As long as profit and revenue take precedence over human life, there is little hope for change.